Impact of declining renal function on multiple myeloma (MM) mortality in the U.S. (1999-2023): A regression analysis using the CDC WONDER database.

Abstract

e19570 Background: MM often leads to renal complications, including acute kidney injury (AKI) and chronic kidney disease (CKD), requiring dialysis and increasing mortality risk, especially in older adults. This study investigates trends and demographics of renal-related deaths in MM patients, with a focus on the preferred place of death (PPOD) in the U.S. Methods: A nationwide U.S. healthcare database, CDC WONDER, was utilized to assess mortality trends in patients over >15 years. Mortality data were categorized using the ICD-10 codes: C90 for MM, N17-N19 for renal failure, R94.4 for abnormal kidney function studies, and Y84.1 for kidney dialysis. Joinpoint 5.0 software was used for regression analysis to evaluate mortality trends. Data were stratified by demographic factors, including census region, race, sex, and PPOD. Results: The overall trends indicated a significant decrease in renal-related mortality from 2003 to 2023 (APC-0.8299, p-value =0.001214]). On census stratification, significant decline in mortality in the Northeast (1999-2023: APC [-1.5628], p = [0.000006]) and the Midwest (1999-2023 APC [-1.0639*], p = 0.000014]). The South also showed significant increasing trends from 1999 to 2004, (APC [3.3088], p = [0.033038]). By race, notable increases were observed in the Asian population (1999-2023: APC [2.3982], p = [0.000112 and a significant decrease in trends in the White population (2002-2023: APC [-1.0381], p = [insert value]; 2015-2023: APC [insert value], p = [insert value]). For sex stratification, females showed significant mortality increases, with trends from 2001 to 2012 (APC [-1.0381], p = [0.000088]). Regarding PPOD, deaths in hospice settings showed increasing trends from 2003 to 2023 (APC [1.1569], p-value = [0.003478]), while mortality in medical facilities declined from 2003 to 2020 (APC -2.7647], p-value = [ 0.000001]), followed by an insignificant surge from 2020 to 2023. Conclusions: Our study revealed a significant decrease in renal-related mortality among MM patients from 1999 to 2023, especially in the Northeast and Midwest. While a disparity is notable in the South region with significant increasing trends from 1999-2004. The findings emphasize the declining impact of renal failure and related complications on mortality in MM. Additionally, shifts in the PPOD highlight changing end-of-life care patterns, with a notable rise in deaths occurring outside the medical facilities. These trends required further investigation of possible causes to evaluate mortality and the evolving patterns of better utilization of hospice.